Luke C. Mullany, PhD ’05 in International Health and MHS ’02 in Biostatistics
Professor of International Health, Johns Hopkins Bloomberg School of Public Health
Johns Hopkins University Alumni Association 2015 Global Achievement Award Recipient
While volunteering for an aid organization in Angola, Luke Mullany, MHS ’02, PhD ’05, realized public health was his calling. The country’s decades-long civil war was raging. Mullany saw landmine injuries and gunshot wounds at the rural village clinic where he worked. Power outages disrupted clinical care and vaccine distribution. He began to see first-hand how health isn’t always determined at the individual level. Before leaving for Angola, he had been accepted by Johns Hopkins School of Medicine, but when he returned he enrolled instead at the Bloomberg School to develop the skills he needed to serve populations most vulnerable to circumstances—such as political conflicts and economic constraints—that were out of their control. His research ever since has reflected this commitment to improve the lives of these people. The World Health Organization and over a dozen countries, for example, have recently changed newborn care recommendations—affecting millions of lives every year—based on studies he first began as a doctoral student in the Department of International Health. As Joanne Katz, MS, ScD, professor, International Health, sums it up, “His work embodies our Bloomberg School vision: Protecting health, saving lives—millions at a time.”
Mullany comes from a long line of physicians, and he always intended to continue in the family medical tradition. Before he began his medical training, however, he volunteered for a year with the Institute for International of Cooperation and Development, an organization similar to the Peace Corps. He worked on a polio vaccination campaign and a child growth-monitoring program in the rural Angolan village of Ambriz. It was there he first experienced the challenges of implementing programs in a rural and resource-poor setting. His medical perspective of health began to be informed by population-level issues such as health systems, economics and politics. He realized that individual health is often susceptible to forces outside of a person’s control. “For instance,” Mullany remarks, “individuals don’t even have the choice to be vaccinated when there is no stable supply of electricity to support a cold chain for vaccine distribution.”
As a master’s student in Biostatistics under the mentorship of Chris Beyrer, MD, MPH ’91, professor, Epidemiology, Mullany travelled to the Thai-Burma border to assist local organizations serving the needs of oppressed ethnic minorities in Burma. Mullany helped community-based organizations design a training program called Mobile Obstetric Medics, or MOM. The project partnered with the Mae Tao Clinic—founded by the Burmese doctor-in-exile Cynthia Maung—to increase access to maternal health care services for internally displaced women in eastern Burma. He also partnered with the Global Health Access Program to measure the mortality rate of these displaced populations. Their surveys showed mortality rates were multiple times higher than populations just across the border in Thailand. “To draw attention to human rights violations, it is important to be able to measure and document them. And that’s what Hopkins and my time on the border taught me to do,” explains Mullany.
“I owe much of my success to fantastic mentors, including James Tielsch, Joanne Katz, and Chris Beyrer. Mentors are keys to success—Hopkins has great ones, and I’ve been lucky to be guided by them,” Mullany professes. When Mullany began his doctoral program, he was recruited by James Tielsch, MHSc ‘79, PhD ’83, adjunct professor, International Health, to assist with data management for a large iron and zinc supplementation project in Nepal. The program began monitoring children at 1 month of age. At the time, little research was devoted to developing low-cost interventions to reduce mortality among newborns under 30 days old. Since these deaths accounted (and still account) for a large proportion of mortality of children under 5, Mullany, with Tielsch’s assistance, added on a new study to test a simple infection-control intervention during the first few weeks of life. This new study demonstrated that the application of an inexpensive antiseptic (chlorhexidine) to umbilical cords reduced newborn mortality by over one-third. After Mullany and other researchers in the field tested and confirmed these findings, the WHO added chlorhexidine to its Model List of Essential Medicines for Children and recommended it globally for babies born in high-risk settings. Over a dozen countries have also adopted umbilical cord cleaning in their national policy recommendations. This success story has already saved thousands of children’s lives and could potentially save hundreds of thousands of babies per year.
Over the last decade there has been considerable improvements in newborn survival, and Mullany has shifted his focus to the prevention and care of pre-term births among vulnerable populations. “Whether it’s rural Nepal or downtown Baltimore, pre-term birth is the leading cause of death of children under 5,” he explains. He’s currently conducting a large-scale trial to study the common South Asia practice of massaging infants with mustard seed oil. His study compares using the standard mustard seed oil with sunflower seed oil. Sunflower seed oil—high in linoleic acid—has been shown to improve skin barrier function. Since the skin is underdeveloped in pre-term babies, leaving them more susceptible to infection, accelerating its development could save countless pre-term infants.
“However, it is prevention of pre-term births, not care of these babies, that is the holy grail,” Mullany explains. Because caring for these infants is so intensive, it is especially crucial in lower income countries. While there still is no solution at hand, he is encouraged. In August, Mullany received funding from the Bill and Melinda Gates Foundation to conduct a study to investigate the association between the oral health status of pregnant women and pre-term birth in Nepal. Some studies in the United States and Europe have shown a link between the two, but there is little research on this topic done in low-income countries. Mullany’s study will also test whether low-cost interventions such as oral rinses would be acceptable and feasible in these communities. If an association is found, he hopes to conduct a larger scale intervention that could contribute to discovering how to prevent the single biggest cause of death among this most vulnerable of populations. Whatever the results of the study, Tielsch has tremendous confidence in Mullany as a leader in global health research. “Attention to detail and a significant presence is required to conduct high quality field work,” says Tielsch, “and Luke is a classic field hound, happiest when he’s in the trenches supervising the day-to-day operations and problem solving with his local team. It’s his commitment to quality and his understanding of what that takes for local staff that makes him so effective as a principal investigator and a true partner for local colleagues.”